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APPLICATION FOR SANITATION PERMIT (Co�ete in Dulicafe) Jf f 0 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein�described, r3 This -in,complianc- ith County Ordinance No. 549. B / .�� 9Y /X1 Wi11y 74 Wig11eV JOB ADDRESS AND LOCATION--- _ ,�� f9WP— 7_09A1 VVeg?` s%&D JVBi Se- Owner's Name -J _ . -- ----------- Phone---- -- ---------- Contractor's Name_ ---------•---------------------------------------------------------- r ---- ------- - Phone-- Installation will serve: Residence 1p�� Apartment House j "J ?""---`-- [� Number of bedroom Commercial ❑ Trailer Court ❑ Motel ❑ Other E]Number of living units: Number of baths [A Loi- size__�O_*_91- Wafer �`�� Wafer Supply: Publics stem r�} Y Community system Y Y ❑ Private � Character of soil to a depth of 3 feet: Sand ❑ Gravel F ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [ Hardpan TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool peirniffed if public.sewer is available within 200 feet.) ` Septic Tank: I P Distance from nearest �_____-Distance from foundation___ � No. of com artments--_ Capacity-. ---------.Material_-01/1�C +F?9{ p �------- Liquid depth_-,-$"- Cesspool: Distance from nearest well------- ------Distance from foundation__---_------__--_.Lining material_""_" ""_""______ __ ❑ Size. Diameter-------------------------------------- Depth-------- -- -- ------- - - - '-Priv Di - - --- ---------- ----- ' Y: stance from nearest well _ ' ---------------- -_-__--__-Distance from nearest building Distance to nearest lot line_ ---------- Distance to nearest well---------_-------Distance from foundation-------------_----Distance to nearest lot line ____ """_. Seepage ifi: ❑ Number of pits-----__--_""____------Lining material-------_-------------Size: Diameter_--_---------___ th 1h, Disp Field: Distance from nearest well---' S`__Distance from foundation_ `,�__ " "Depres Number; of lines-"___ �- ----.Distance to nearest lot line_ a Length of each line" . � __-___ rr Width of trench--_ Type of filter mate ial _� t Qui „Depth of filter material 'Remodeling and/or repairing (describe}:""_- -- - --------------------------------- -- - n �_/----- 7 (:f--- --- -- wlv ---- -- ------ - - ------------ -- --- ---- I hereby certify That I have prepae6dis--app-1-icatio n and thof fhe work will be done in accordance wifh San Joaquin Counordinances, A Vfv;s.'and rules and' ions of the San Joaquin.Local Health District. ffte (Signed)------ " - Lac" Owner an or Co tractor (Plot plans, showing si e 0 -_-- f------------- k - -------------- (Title)-------- - -------- ---------- lot, location of system in relation o wells, , etc., must bfiled Jim his a . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_"__ _ _ - - — VIEWED BY----------------------- ------ DATE------- ,..� BUILDING PERMIT ISSUED - -------------- ----------------------- ---------------------------------- DATE - ------------------------------------------------------ Alterations and/or recommendations:_ DATE "_ -------------- ------------------------- -------------- ------------------ ------------------- ----- _---- ------ --------------------- ----------- PERMIT No -------- ------------ ------- -._--- ISSUED_""__-_.""_" l_ _ (Date) FINAL INSPECTION BY'-- • ---------------- Date---- --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ES-9-2M 9-50 W4639 Stockton, California